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Full text of "Strategic Plan for Implementing Cultural Competence Standards in Managed Care Mental Health Services for Four Underserved/Underrepresented Racial/Ethnic Groups"

Strategic Plan for 
Implementing 

Cultural 
^^4 Competence 

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X Four Underserved/Underrepresented 
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Strategic Plan For Implementing 

Cultural Competence Standards 

In Managed Care 
Mental Health Services For 

FourUnderserved/Underrepresented 
Racial/Ethnic Groups 



December 1997 



Funded by 

Center for Mental Health Services 
Substance Abuse and Mental Health Services Administration 



Sponsored by 

Western Interstate Commission for Higher Education (WICHE) 
Mental Health Program 



STRATEGIC PLAN FOR IMPLEMENTING THE 
CULTURAL COMPETENCE STANDARDS 

TABLE OF CONTENTS 

I. CULTURAL COMPETENCE STANDARDS 3 

A. Overview of Standards 3 

B. Standards 4 

II. COMPONENTS OF IMPLEMENTATION PLAN 7 

III. PRIORITY ISSUES TO ADDRESS IN IMPLEMENTATION PLAN 8 

IV. IMPLEMENTATION PLAN PROCESS 10 

A. Phases of Overall Implementation Plan 10 

B. Marketing Plan 13 

C. Process of Site Implementation 15 

D. Roles and Responsibilities of Implementation of Standards 17 

E. Funding Issues 18 

F. Timeline for Implementation 19 



L 



STRATEGIC PLAN FOR IMPLEMENTING THE 
CULTURAL COMPETENCE STANDARDS 



The primary goal of the Cultural Competence Standards is to promote the systematic 
development of culturally competent public and private systems of care. 

& 

The primary goal of the Implementation Plan is to achieve systematic distribution 

and implementation of the Standards. 



I. CULTURAL COMPETENCE STANDARDS 



A. Overview of Standards 

The "ideal" culturally competent system of care incorporates, at all levels of operation, the 
importance of culture, the assessment of cross-cultural relations, vigilance towards the 
dynamics that result from cultural differences, the expansion of cultural knowledge, and 
the adaptation of services to meet culturally unique needs. In addition, the "ideal" 
culturally competent system of care demonstrates a value for diversity, has the capacity 
for cultural self-assessment, shows awareness of the dynamics inherent when culture 
interacts, institutionalizes cultural knowledge, and develops adaptations to diversity. 
Finally, the culturally competent system incorporates the concept of equal and 
nondiscriminatory services as well as the concept of responsive services matched to the 
unique cultural and linguistic needs of consumers. 

The Cultural Competence Standards were developed by four national racial/ethnic panels 
(African American, Asian/Pacific Islander American, Latino/Hispanic, and Native 
American/American Indian/Native Alaskan/Native Hawaiian) with the recognition that, in 
order to provide individualized mental health services, consumers must be viewed within 
the context of their cultural group and their experiences from being part of that group. 
Consequently, staff training which enables them to understand the cultural background 
and needs of a consumer is a critical element of a culturally competent system of care. 
Cultural competence training is intended to help the service provider from another culture 
become better able to understand and communicate with the consumer who is from one 
of many national origins or ethnic backgrounds. It will not, of course, permit an individual 
to take two or three courses and become totally competent in understanding and treating 
someone with different life experiences, language, and cultural background. Acquiring 
cultural competency is a long-term, ongoing, developmental process at the individual, 
professional, and organizational levels. 

The Americans with Disabilities Act of 1990 and Title VI of the Civil Rights Act of 1964, as 
amended, both mandate accessibility to programs and the facilities at which services are 
dispensed. It is therefore critical for public and private agencies to be staffed with 
culturally competent and appropriately qualified bicultural and bilingual personnel. To help 
meet this requirement, the Cultural Competence Standards recommend that cultural 



competence training be provided to all direct care staff and those with management 
oversight responsibilities. The goal of the training program is to promote the systematic 
development of culturally competent systems of care. 



B. Cultural Competence Standards 

Overall System Standards: 

1. Cultural Competence Planning 

A Cultural Competence Plan for both public and private sectors shall be developed 
and integrated within the overall organization and/or provider network plan, using 
an incremental strategic approach for its achievement, to assure attainment of 
cultural competence within manageable but concrete timelines. 

2. Governance 

Each health plan's governing entity shall incorporate a board, advisory committee, 
or policy-making and -influencing group, which shall be proportionally 
representative of the consumer populations to be served and the community at 
large, including age and ethnicity. In this manner, the community served will guide 
policy formulation and decision-making, including Request for Proposals 
development and vendor selection. The governing entity responsible for the Health 
Plan shall be accountable for its successful implementation, including its cultural 
competence provisions. 

3. Benefit Design 

The Health Plan shall ensure equitable access and comparability of benefits across 
populations and age groups. Coverage shall provide for access to a full continuum 
of care (including prevention programs) from most to least restrictive in ways which 
are comparable, though not identical, acknowledging that culturally competent 
practice provides for variation in individualized care. 

4. Prevention, Education, and Outreach 

Each Managed Care Mental Health Plan shall have a prevention, education, and 
outreach program which is an integral part of the Plan's operations and which is 
guided in its development and implementation by consumers, families, and 
community-based organizations. 

5. Quality Monitoring and Improvement 

The Health Plan shall have a regular quality monitoring and improvement program that 
ensures: (1) access to a full array of culturally competent treatment modalities, (2) 
comparability of benefits, and (3) comparable successful outcomes for all service 
recipients. 



6. Decision Support and Management Information Systems 



The Health Plan shall develop and maintain a database which will track utilization and 
outcomes for the four groups across all levels of care, ensuring comparability of benefits, 
access, and outcomes. The Health Plan shall also develop and maintain databases of 
social and mental health indicators on the covered population from the four groups and 
the community at large. 

7. Human Resource Development 

Staff training and development in the areas of cultural competence and racial/ethnic 
mental health shall be implemented at all levels and across disciplines, for leadership and 
governing entities, as well as for management and support staff. The strengths brought 
by cultural competence help form the foundation for systemwide performance rather than 
detract or formulate separate agendas. 

Clinical Standards 

8. Access and Service Authorization 

Services shall be provided irrespective of immigration status, insurance coverage, and 
language. Access to services shall be individually- and family-oriented (including client- 
defined family) in the context of racial/ethnic cultural values. Access criteria for different 
levels of care shall include health/medical, behavior, and functioning in addition to 
diagnosis. Criteria shall be multidimensional in six domains: psychiatric, medical, 
spiritual, social functioning, behavior, and community support. 

9. Triage and Assessment 

Assessment shall have a multi-dimensional focus and include individual, family, and 
community strengths; functional, psychiatric, medical, and social status; as well as family 
support. 

10. Care Planning 

Care plans for consumers from the four groups shall be compatible with the cultural 
framework and community environment of consumers and family members. When 
appropriate, care plans shall involve culturally indicated family leaders and decision 
makers. 

1 1 . Plan of Treatment 

The Treatment Plan for consumers from the four groups shall be relevant to their culture 
and life experiences. It shall be developed by or under the guidance of a culturally 
competent provider in conjunction with the consumer, and where appropriate, the family. 

12. Treatment Services 

The Health Plan shall assure that the full array of generally available treatment modalities 
are tailored such that they are culturally acceptable and effective with populations of the 
four groups (e.g., psycho-education, psychosocial rehabilitation, family therapy, 
specialized group therapy, behavioral approaches, use of traditional healers, and 
outreachj. 



13. Discharge Planning 

Discharge planning for consumers and families from the four groups shall include 
involvement of the consumer and family in the development and implementation of the 
plan and evaluation of outcomes. Discharge planning shall be done within a culturally 
competent framework and in a communication style congruent with the consumer's 
values. The plan shall allow for transfer to less restrictive levels of care in addition to 
termination of treatment based on accomplishment of mutually agreed upon goals in the 
Treatment Plan. 

14. Case Management 

Case management shall be central to the operation of the interdisciplinary treatment team 
and shall be based on the level of care needed by the primary consumer. Case managers 
for consumers from the four groups shall have special skills in advocacy, access of 
community-based services and systems, and interagency coordination. Case 
management shall also be consumer- and family-driven. Case managers shall be 
accountable for the cost and appropriateness of the services they coordinate. The 
managed care plan shall maintain responsibility for the successful and appropriate 
implementation of the case management plan and providing adequate administrative 
resources and endorsement. 

15. Communication Styles and Cross-cultural Linguistic and Communication Support 

Cross-cultural communication support to participate in all services shall be provided at the 
option of consumers and families at no additional cost to them. Access to these services 
shall be available at the point of entry into the system and throughout the course of 
services. 

16. Self Help 

Culturally competent self-help groups shall be created to provide services to consumers 
from the four groups and their families. The self-help groups shall function as part of a 
continuum of care. Self-help groups for consumers from the four groups shall incorporate 
consumer-driven goals and objectives that are functionally defined and oriented toward 
rehabilitative and recovery outcomes. Equal consideration and support shall be given to 
family and primary consumer self-help groups. 

Provider Competencies 

17. Knowledge, Understanding, Skills, and Attitudes 

Specific areas of knowledge and understanding, skills, and attitudes (as identified in the 
Cultural Competence Standards document) shall be essential components of core 
continuing education to ensure cultural competence among clinical staff and to promote 
effective response to the mental health needs of individuals from the four groups. 



c 



II. Components of Implementation Plan 



A. Maintaining the Integrity of the Cultural Competence Standards 

Cultural Competence requires a highly specialized developmental, long term, multi-stage 
process to implement. It is strongly recommended that any participating public or private 
organization should utilize qualified racial/ethnic consultants recognized at the community, 
regional, and national levels as well as racial/ethnic Mental Health Specialists during the 
implementation process of the Cultural Competence Standards. This requirement is 
necessary to maintain the integrity of the goals, objectives, and "best practices standards" 
that are inherent in the Cultural Competence Standards and to promote total quality 
management standards during the implementation process within various organizations. 



B. Commitment of Participating Agencies 

To maximize agency participation and cooperation during the implementation process of 
the Cultural Competence Standards, participating managed care organizations should 
demonstrate a defined commitment to serve underserved, underrepresented racial/ethnic 
consumers. For example, managed care organizations might want to establish specific 
cultural competence practices, have clinically qualified and diversified staffing, and provide 
resources for cultural competence activities. It should be recognized that many 
racial/ethnic communities and consumers will have a very low level of trust with a 
managed care organization. Agencies should assure that racial/ethnic populations are 
central to this process. 



C. Management/Oversight of Implementation Process 

An administrative unit, directed by and accountable to the organization's governing entity, 
should be established to manage the Cultural Competence Implementation Process. The 
administrative unit responsibilities should include: 

1 . Management of staff and consultants; 

2. Administration and negotiation of contracts with participating organizations; 

3. Coordination of arrangements and activities; 

4. Oversight of budgets and payments; and 

5. Fund development. 



D. Participation of Underserved/Underrepresented Racial/Ethnic Panels in 
the Implementation Plan Process 

The ongoing participation of the four National Racial/Ethnic Panels in the implementation 
process is necessary to maintain the integrity of the goals, objectives and "best practices 
standards" that are inherent in the Cultural Competence Standards and to promote total 
quality management standards during the implementation process within various 
organizations. The responsibilities of the four National Panels should include: 

1 . Design ongoing development and refinement of the standards; 

2. Design strategies to upgrade the Standards to professional standards; 

3. Disseminate materials and determining to whom and under what conditions; 



4. Create Implementation Plan procedures, training materials and quality management 
measures; 

5. Develop training methods and consultation fee structures to provide training and/or 
technical assistance to agencies; 

6. Manage or sponsor training activities and continued refinement of these activities; and 

7. Advocate on behalf of payers to incorporate Standards (i.e., legislation). 



III. PRIORITY ISSUES ADDRESSED IN IMPLEMENTATION PLAN 

The Cultural Competence Standards are made up of exemplary programs and practices, 
most of them implemented by members of the four racial/ethnic panels. The following 
additional priority issues and problems in mental health care to underserved, 
underrepresented racial/ethnic populations will, therefore, be addressed through 
implementation of the Standards. Recommended solutions identified below to address 
the problems have been offered by members of the racial/ethnic panels and other mental 
health professionals. 

A. Representative Participation in Work Force 

Issue: Recruitment, employment, retention, and promotion of qualified culturally 
competent mental health professionals to plan, staff, and manage appropriate mental 
health services for racial/ethnic populations. 

Recommendations : 

• Scholarships and fellowships should be available which adequately support 
underserved, underrepresented racial/ethnic populations enrolled in academic 
programs that train them for behavioral health careers; 

• Enhance students' sense of belonging by providing evidence of valuing their 
cultures through more than token examples of faculty from their respective 
ethnic/racial backgrounds; 

• Increase content on cultural diversity in training institutions' curricula; 

• Provide field experience that involves culturally, ethnically, racially, and 
linguistically diverse clients or research subjects, and include in-service training 
in multicultural issues; 

• Establish an organizational environment supportive of training and research in 
multicultural issues; 

• Create career ladders for developing and advancing racial/ethnic staff; and, 

• Consider paying staff for specific skills rather than for higher degrees. 



B. Quantity and Design of Programs 

Issue: Limited and inappropriately designed and inadequately staffed mental health 
treatment programs to respond to the special needs of racial/ethnic populations. 

Recommendations: 

• Design programs with a specific philosophy and service model based on 
principles of cultural competence; 

• Make special effort to recruit and retain at least a proportional representative 
percentage of mental health professionals from each of the racial/ethnic groups 
being served; 

8 



• Require cultural competence training for all staff; 

• Specify continuing education requirements and performance-based standards 
for developing, maintaining, and continuing clinically and culturally competent 
mental health providers; and 

• Require cultural competence training prior to licensing or certification and for 
renewals. 

C. Qualified Interpreters 

Issue : Shortage of culturally competent bilingual/bicultural staff able to serve and facilitate 
communication with racial/ethnic populations. 

Recommendations: 

• Mandate that mental health programs use culturally competent staff to serve 
and facilitate communication with racial/ethnic populations. In the absence of 
culturally competent staff, qualified interpreters may be used to facilitate 
communication at all levels of care between consumers and providers of mental 
health services. It should be noted, however, that using interpreters rather than 
qualified bilingual and bicultural professionals increases the potential risk and 
liability resulting from misdiagnosis and inappropriate treatment that may 
increase lengths of stay and costs; and 

• Establish a directory (updated annually) of paid trained interpreters ready to 
assist providers when bilingual culturally competent staff are not available. 

D. Quality Care 

Issue: Quality care is a requirement under the Civil Rights Act of 1964, as amended. 
There are several critical issues and concerns that need to be addressed: 

1 . Accessibility of services. 

2. Service utilization and outcome data. 

3. Meeting the needs of special populations (e.g., children, elders, geriatric, rural, urban, 
dual diagnosis, disabled, undocumented persons) and producing comparable positive 
outcomes. 

4. Quality of translators of communication across cultures. 

5. Models of care and components of care. 

Recommendations: 

• Acknowledgment of racial/ethnic cultural models of care which support 
culture specific philosophies of healing and health as well as 
acknowledging European-based models of care; 

• Integrated primary care, mental health, substance abuse, etc.; 

• Community-based organizations, which means being located in the 
community and connected to community networks; 

• Seamless entry point into system from a community base; 

• Design and development of appropriate systems of care; and 

• Gate-keeping and gateways into systems of care. 



E. Community Empowerment and System Change 

Issue : Need for empowerment of racial/ethnic communities and changes in systems of 
care (Total Quality Management): 

1 . Ensure culturally competent managed care systems through regulation 
and enforcement as well as work towards best practices; 

2. Local health care system responds to community needs; 

3. Empower racial/ethnic communities to impact significantly the 
development and formulation of managed systems of care; 

4. Encourage consumer empowerment and activism; and 

5. Reduce discrimination and lack of parity in services for racial/ethnic populations. 



IV. Implementation Plan Process 

A. Phases of Overall Implementation Plan 

1. Conceptual Base/Acceptance (Formulate conceptual base and establish acceptance 
of practice Standards) 

a. Develop a conceptual base or model that incorporates the role and 
perspectives of racial/ethnic cultures as well as the European medical 
model. The European model itself did not incorporate the roles and 
perspectives of racial/ethnic cultures and has been less successful with 
them. 

b. Acceptance would be served by a 'phasing in' process and therefore the 
pilot testing has great merit (Pilot testing is a reciprocal process whereby 
both the managed health care organization and the racial/ethnic community 
are learning together). 

c. Best practices. 

d. Historical and epidemiological perspective or demographics and racial/ 
ethnic mental health services (e.g., homeless, migrant, undocumented). 

2. Dissemination/Marketing (see Marketing Plan) 

The key players include the managed health care organizations and a number of other 
entities (e.g., state legislators, federal, state, and county government agencies, State 
Mental Health Authorities, private insurance companies, Medicaid agencies, 
Governors (NGA), National Association of County Organizations (NACO), providers of 
care, guild organizations, national racial/ethnic-related organizations, higher education 
institutions). 

3. Integration Into Overall Cultural Standards 

a. Cultural Competence Standards being developed by Asian/Pacific Islander, 
Latino, African American, and Native American panels will be reviewed at a 
National Consensus Conference in June/July, 1997 for universal principles 
and uniqueness within cultures to determine what modifications are needed 
for multicultural standards. 

b. Multicultural tools will be developed for pilot sites where the service area 
population is multicultural. 

10 



c 



4. Pilot Testing of Standards - Selection of Pilot Sites (See Section III) 
Potential Pilot Testing Sites for Cultural Competence Standards 

(identified by National Racial/Ethnic Panels) 



African American 


Asian American 


Latino 


Native American 






Arizona 






California 

• LA 

• Sacramento 

• San Francisco 

& Bay Area 

• Central Valley 


California 

• Santa Clara 

• Ventura 

• LA 


California 

• San Diego 

• Rural Indian 

Health Board 




Hawaii 

• Honolulu 








Illinois 

• Chicago 








Massachusetts 
• Boston 


Massachusetts 








Michigan 










Minnesota 

• Minneapolis 






New Mexico 
• Las Cruces 






New York 










Oklahoma 


Oklahoma 

• Oklahoma City 






Texas 




Washington 
• Seattle 


Washington 
• Seattle 


Washington 
• Seattle 


Washington 
• Seattle 



Criteria for Pilot or Implementation Sites 

1. Commitment and support by the State Mental Health Authority to 
implement the standards. 

2. Commitment and support at the County Mental Health Director level to 
implement the standards: 

• Commitment and support from the governing board of the agency 

• Commitment and support of the Executive Director of the agency 

3. The Program should be strategically situated in an area with significant 
numbers of ethnic populations and caseloads. 

4. The Program should have (to some degree) staff who have cultural 
competency skills and knowledge and can relate to the community. 

5. The Program should be willing to implement the Standards. 

6. State with a cultural competency plan (preferred but not required). 



11 



Potential pilot sites for implementing the Cultural Competence Standards should be 
selected on the basis of pre-established criteria, merits of written proposals, and the 
degree to which the potential pilot site will contribute to the advancement of the overall 
goals and objectives of the Standards. Consideration should be given to regional 
characteristics, (i.e., East, West, North, and South, as well as characteristics such as 
urban, agricultural, etc.) 

a. Identify "ready areas." (Sites on previous page have been identified as 
potential pilot testing areas by some of the National Racial/Ethnic Panel 
members. Others will be added). 

b. Explore funding opportunities 

• Federal programs or grants, (e.g. KDA Community Action Grant) 

• State/local resources for pilot sites 

• Private organizations (funding for private pilots) 

• Managed Health Care Organizations 

c. Set criteria for Request for Applications (RFA) for Pilot Sites: 

• Preference to public systems 

• Ability to pair public systems with experienced consultants 

• Evaluation of Standards required in sites 

• Integrate evaluation Standards 

• RFAs for evaluation of self-funded sites 

• Preference to existing collaborations and networks 

d. Determine Outcomes from Pilot Sites, including: 

• Procedures for enhancing dissemination/acceptance 

• Procedures for program/training evaluation and refinement of 
Standards 

• Augmenting dissemination/acceptance 
. • Evaluation of Standards 

5. Identification of Key Players (funders and policy makers) 

a. Identify entities that control contracts for managed care organizations, e.g.: 

• State Legislatures 

• Federal, state, and county governments 

• State Mental Health Authorities 

• Private insurance companies 

b. Design strategies/approaches to influence key players 

• Emphasize cost effectiveness of having appropriate culturally 
competent Standards 

• Use clear and specific language with legislators in literature, 
presentations, etc. 

• Deliver brief, personalized presentations at conferences to 
special groups and to key individuals 

• Convene public/private forums 

c. Consider funding criteria/requirements to be met 

6. Political Strategies 

a. Develop plans for impacting mandates for funding from: 

• Local government (propose commitment of local governing 
entitles to cultural competency in agency plan); 

12 



c 



• State government, (e.g., propose commitment of State Mental 
Health Authority to cultural competency in State Plan); 

• Federal government, (e.g., propose language in Block Grant 
Appropriation Law mandating cultural competency); 

b. Develop and establish partnerships with consumer coalitions; 

c. Develop and establish partnerships with family coalitions, (e.g., National 
Alliance of Mentally III [NAMI], Program of Assertive Community Treatment 
[PACT]); and 

d. Develop and establish partnerships, and build coalitions, with advocacy 
groups. 

7. Overall Evaluation of Implementation Plan (Central Clearinghouse) 

a. Track marketing/lobbying efforts; 

b. Track implementation sites; and 

c. Continue to tailor Mental Health Statistical Improvement Program (MHSIP) 
Report Card to incorporate measurement of cultural competence capacity 
and outcomes. 

8. Technical Assistance Centers 

a. Establish Technical Assistance Centers within management entity to 
develop consultation contracts; 

b. Establish core group of technical assistance consultants using following 
criteria: 

• Clinical, administrative, evaluation, research, consultation, group 
process skills, and expertise 

• Cultural competence skills and background 

• Finance, Management Information Systems, and linguistic 
support expertise 

c. Establish community boards which involve consumers and family; and 

d. Ensure TA Centers' understanding/expertise of Standards (essential). 

9. Standards and Certification 

a. Establish standards for certification 

b. Establish certification program 



B. Marketing Plan 

A primary focus of the marketing plan and participation of the National Racial/Ethnic 
Panels will be to develop a strong foundation for accountability in the implementation 
process and to develop strong relationships and collaborations with key groups and 
credentialing agencies. Participation of the National Racial/Ethnic Panels in the 
implementation process is necessary to maintain the integrity of the goals, objectives, and 
"best practices standards" that are inherent in the Cultural Competence Standards and to 
promote total quality management standards during the implementation process within 
various organizations. 

1. The Marketing Plan will include provisions for ongoing development, refinement, and 
upgrading of the Cultural Competence Standards, including: 

13 



a. Strategies to refine the Standards, 

b. Dissemination of materials in a manner that promotes quality of care for 
underserved/underrepresented racial/ethnic consumers, and 

c. Development of implementation plan procedures, curricula, training 
materials, and quality management measures. 

2. The Marketing Plan will promote the participation of the following groups: 

a. Government, e.g., 

• State Mental Health Authorities 

• Medicaid agencies 

• Legislators 

• National Governors Association (NGA) 

• National Council for Community Behavioral Healthcare 

b. Providers of care 

c. Guild organizations 

d. Advocacy organizations, e.g. 

• National Mental Health Association (NMHA) 

• National Alliance for the Mentally III (NAMI) 

e. Managed Care Organizations 

f. National racial/ethnic related organizations 

g. Higher Education Institutions 

h. Private funding sources such as United Way and foundations 

3. The Marketing Plan will utilize the following promotion methods: 

a. Public education and advocacy, via 

• Organizational newsletter circulation 

• Trade publications 

• Web publications/reports (e.g., Knowledge Exchange Network, 
SAMHSA, WICHE Home Page) 

• Presentations 

b. And in collaboration with 

• Provider, Professional, Advocacy organizations 

• Mental Health focused organizations 

• Organizations developing managed care mental health standards 

• Public education of racial/ethnic consumers 

4. Marketing Plan potential funding sources: 

a. Federal government agencies 

b. State government agencies 

c. Local government agencies 

d. Managed care organizations and other direct care providers 

e. Pharmaceutical companies 

f. Private foundations 



5. Rationale for implementing the Cultural Competence Standards: 
a. Cost Effectiveness 

14 



b. Quality Care 

c. Greater access to mental health care for racial/ethnic populations 

d. Political correctness 



C. Process of Site Implementation (Include in contractual requirements) 

1. Infrastructure/Criteria for Site Selection: 

a. Organizational stability (staff, leadership). 

b. Commitment to cultural competence philosophy and values with careful 
planning to work out respectful collaborations and protocols with 
traditional cultural healers. 

c. Commitment of resources, including budget for training and staff. 

d. Culture of Continuous Quality Improvement (CQI). 
development and hiring bilingual/bicultural staff and/or consultants. 

e. Cultural competency training included in staff development plan. 

f. Array of services. 

g. Inclusion of contract service providers 

h. Commitment to consumer data input (essential). 

2. Self Assessment: 

a. Cultural competency organization and provider assessment tools 

b. Management information system (MIS) access 

3. Governance: 

a. Consumer and community involvement, particularly racial/ethnic 
populations and advocates 

b. Consultation/training with governing body or developing body 



4. System: 



a. Invitation of non-contract private providers 

b. Explore CBO involvement 

c. Review services array 

d. Review services structure 

e. Review system coordination 

f. Review management information system (MIS) plan 



5. Management: 



a. Set standards and establish protocols for review 

b. Review clinical supervision 

c. Review Quality Assurance/Quality Improvement/Utilization Review 

d. Review staffing patterns/ratios/recruitment/retention 

e. Review training plan for staff 

f. Review education plan for consumers 

g. Review Policies and Procedures 



15 



6. Clinical services: 



a. Access/triage 

b. Case management 

c. Treatment protocols 

d. Assessment protocols 

e. Linguistic needs 



7. Evaluation process: 



C 



a. Continual follow-up 

b. Guideline indicators (process and outcome) 

c. Evaluation design (pre/post, control communities, longitudinal) 

d. Access to management information systems (MIS) 

e. Access to stakeholders for surveys 

8. Core Staff Structure: 

a. Project director 

b. Project coordinator 

c. Technical assistant consultant 

9. Technical Assistance Contract Specifications: 

a. Technical assistance consultants' qualifications: 

• Clinically certified 

• Bilingual/bicultural 

• Clinical and administrative experience 

• "Subject matter" expert 

• Consultation skills/group process skills 

• Understanding of, and fidelity to, model 

• Evaluation skills 

• Management information system (MIS) skills 

b. Components of Technical Assistance Team: 

• Clinical expert 

• Training expert 

• Evaluation expert 

• Administrative expert 

• Consumer expert 

c. Infrastructure Entity: 

• Management 

• Funding/accountability 

• Analysis of data (outcome, process, training) 

• Support for training (logistics, materials) 

• Access to literature and best practices 



d. Formal Contract should include: 

16 



• Commitment to cultural competence/training/policies 

• Openness to reviewing and re-engineering operations, and to re- 
directing resources 

• Commitment to new services to racial/ethnic populations 

• Commitment to racial/ethnic executives, managers, and staff 

• Commitment to evaluation, full data access, and exterior analysis 

• Commitment to longitudinal development and institutionalization 
of Standards 

e. Technical Assistance Contract Process 

• Contract directly with consultants (National Racial/Ethnic Panels) 

• Contract directly with broker, (e.g., WICHE) 



D. Roles and Responsibilities in Implementation of Standards 

1. National Racial/Ethnic Panels (need to be institutionalized as an ongoing entity) will: 

a. Serve as "The" Technical Assistance Resource Entity 

b. Work towards standards and certification 

c. Refine Standards further 

d. Promote training resource for leaders, managers, and staff 

e. Develop consultation, training, and evaluation tools 

f. Educate public/private entities 

g. Follow up on implementation and quality (longitudinal) 
h. Provide guidance in seeking opportunities 

i. Provide general resources for ongoing participation of Workgroup of 

Racial/Ethnic Panels 
j. Expand group 
k. Train new members 
I. Coordinate work of four racial/ethnic panels 

2. WICHE as Broker will: 

a. Establish formal relationship with National Racial/Ethnic Panels 

b. Honor CMHS commitment - separate from broker function 

c. Develop Networking 

d. Be the clearinghouse and disseminate information 

e. Provide training 

f. Facilitate meetings, conferences, task forces, and committees 

g. Be the liaison/support with Western states 
h. Provide fiscal management resources 

i. Generate resources 

j. Work with National Racial/Ethnic Panels toward becoming a National 
Technical Assistance Center 

3. CMHS will: 

a. Coordinate/network with racial/ethnic panels 

b. Provide funding 

c. Be a clearinghouse and distribute information 

d. Influence the field 

e. Support public mental health development 



17 



L 



4. Other entities involved will include: 

a. States/government (e.g., funding sites) 

b. Substance Abuse and Mental Health Services Administration (SAMHSA) 

c. Center for Substance Abuse Treatment (CSAT) 

d. Center for Substance Abuse Prevention (CSAP) 

e. Health Resources and Services Administration (HRSA) 

f. Health Care Financing Administration (HCFA) 

g. Advocacy organizations 

h. Professional organizations 

i. Managed Care Organizations (funding, pilot sites) 

5. Decision-Making Process 

Formalize relationship between National Racial/Ethnic Panels and WICHE 



E. Funding Issues 

1. Funding Needs 

a. Funding/compensation of National Racial/Ethnic Panel members for 
work/time, technical assistance 

b. Funding for one coordinator and one staff (part-time,) 

c. Funding for evaluation, including financial and multi-systems outcomes 

d. Funding to develop tools 

e. Funding for dissemination/marketing 

f. Funding for travel expenses to national and regional meetings 

g. Funding for a marketing plan 

h. The following funding for each implementation site depends on needs 
assessment: 

• Funding for services 

• Funding for racial/ethnic group leaders, managers, staff 

• Funding for organizational strategic planning 

• Multi-system blended funding for sites 
i. Funding for marketing specialist 

2. Funding Sources 

a. SAMHSA 

b. CMHS, (e.g. KDA Community Action Grants) 

c. States/Counties, (e.g. training resources) 

d. Health Care Financing Administration 

e. Managed Care Organizations, (e.g. staff development resources) 

f. Foundations 

• g. Pharmaceutical companies 
h. Conference sponsors 



3. Funding Recommendation 

FY 1998-99 - $4 million for four minority panels ($1 million per panel) 



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F. Timeline for Implementation of Core Cultural Competence Standards 



Broader dissemination of Standards by WICHE 

Focused dissemination by Racial/Ethnic Panels 

CMHS dissemination (including Internet) 

Initial Marketing Plan 

Implementation Plan completion 

Request for supplemental funding to Pharmaceutical 

Companies and Foundations 

Political/educational activities 

Recruitment of "private" pilots 

National Racial/Ethnic Panel formalization as 

National TA Center 

Formal marketing plan completion 

Screening (training) of trainers 

Funding for pilot sites 

WICHE RFA's to public pilot sites 

Initial Analysis and Evaluation of pilot site data 

Development of accrediting standards 



ASAP 
ASAP-1998 
1997-98 
March 1998 
Dec. 1997 

March/April 1998 
1997-98 
Dec. 1997-98 

1998 

March/April 1998 
Mar-Oct 1998 
FY 1998-99 
FY 1998-99 
FY 1999-2000 
FY 1999-2000 



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